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2023-legislative-session-update-wsma-members-bring-the-physician-voice-to-olympia2023 Legislative Session Update: WSMA Members Bring the Physician Voice to OlympiaLatest_NewsShared_Content/News/Latest_News/2023/2023-legislative-session-update-wsma-members-bring-the-physician-voice-to-olympia<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><a href="https://vimeo.com/796363429"><img src="/images/Newsletters/latest-news/2023/feb/legislative-update-wk-5.png" alt="WSMA Legislative Update: February 6, 2023 logo" /></a></div> <h5>February 6, 2023</h5> <h2>2023 Legislative Session Update: WSMA Members Bring the Physician Voice to Olympia</h2> <p>WSMA President Katina Rue, DO, shares highlights from the 2023 Legislative Summit and ways physicians and PAs can help amplify WSMA's advocacy priorities throughout the legislative session. <a href="https://vimeo.com/796363429">Watch the video</a>.</p> </div>2/6/2023 12:00:00 AM1/1/0001 12:00:00 AM
weekly-rounds-february-3-2023-building-community-and-cultivating-leadersWeekly Rounds: February 3, 2023 - Building Community and Cultivating LeadersLatest_NewsShared_Content/News/Weekly_Rounds/2023/weekly-rounds-february-3-2023-building-community-and-cultivating-leaders<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Weekly%20Rounds/Weekly-Rounds-Article-Graphic-2022-645x425px.png" class="pull-right" alt="Weekly Rounds logo" /></div> <h5>February 3, 2023</h5> <h2>Building Community and Cultivating Leaders</h2> <p> Soon after I write this, I'll be headed to Olympia to attend the WSMA's annual Legislative Summit-finally back in person after two years of virtual gatherings. While our virtual sessions were well-received, remote gatherings are a pale substitute for in-person meetings when it comes to building community. And building community is behind all we do at the WSMA-our leadership in advocacy, professional development, and efforts toward inclusiveness and equity all depend upon a strong foundation of community. </p> <p> And speaking of leadership, I want to flag for you the many opportunities the WSMA is offering in 2023 to further your leadership development. If community is the backbone of our work, physician leadership is its eyes and ears-health care advocacy, both in the policy and clinical arenas, depends upon physicians stepping into leadership roles to ensure health care remains patient-focused and physician-driven. </p> <p> Take a moment to review the following opportunities. Registration is open for all of these 2023 dates, so act now to reserve your spot. I hope to see you at one or more of these sessions! </p> <h3>Physician Leadership Course - March 3-May 12, 2023</h3> <p> The WSMA Physician Leadership Course is our basic "boot camp" to familiarize physicians and physician assistants with the four important components of health care leadership: performance improvement, patient safety, and high reliability; leadership and management of individuals, teams, and organizations; planning and finance; and creating and maintaining a personal leadership development plan. </p> <p> The 11-week hybrid-distance course combines face-to-face and online learning to enable participants to begin developing and honing their leadership skills at their convenience. Only three in-person classes are required: March 3-4 and May 12 at the Silver Cloud Broadway Hotel in Seattle. The remainder of the course is conducted online. This activity has been approved for <em>AMA PRA Category 1 Credit</em>â„¢. <a href="[@]wsma/education/physician_leadership/physician_leadership_course/wsma/physician_leadership/physician_leadership_course/physician_leadership_course.aspx?hkey=efdc4ad1-ff20-4089-ab51-caafbe73572b&_zs=B3aFd1&_zl=aX2o8">Enroll online</a>. </p> <h3>Leadership Development Conference - May 19-20, 2023</h3> <p> Our annual WSMA Leadership Development Conference will be held in person this May in Chelan. Our theme this year is leading transformational change-an appropriate theme for a profession still reeling from the disruptions of a pandemic and its social upheavals. This conference is for all physicians and physician assistants (teams are welcome, as well), regardless of where you are on your leadership journey, your specialty, or your practice setting. Join us this May on the shores of Lake Chelan and find out for yourself why this conference is one of our most popular events. This activity has been approved for <em>AMA PRA Category 1 Credit</em>â„¢. <a href="[@]wsma/events/leadership_development_conference/wsma/events/ldc/leadership_development_conference.aspx?hkey=c7532c38-057a-4568-8a3c-078182469222&_zs=B3aFd1&_zl=bX2o8">Register online</a>. </p> <h3>Physician Leadership Course (fall dates) - Sept. 8-Nov. 17, 2023</h3> <p> The WSMA is pleased to announce a second Physician Leadership Course in 2023 for those physicians and physician assistants unable to enroll in the spring course. This activity has been approved for <em>AMA PRA Category 1 Credit</em>â„¢. <a href="[@]wsma/education/physician_leadership/physician_leadership_course/wsma/physician_leadership/physician_leadership_course/physician_leadership_course.aspx?hkey=efdc4ad1-ff20-4089-ab51-caafbe73572b&_zs=B3aFd1&_zl=aX2o8">Enroll for the fall course online</a>. </p> <h3>Dyad Leadership Course - Sept. 29-Oct. 27, 2023</h3> <p> A month-long hybrid-distance course with three live educational workshop days, the WSMA Dyad Leadership Course is intended for physicians and their administrative dyad partners who wish to improve team function and achieve greater operational success within their clinical system. This activity has been approved for <em>AMA PRA Category 1 Credit</em>â„¢. <a href="[@]wsma/education/physician_leadership/dyad_leadership_course/wsma/physician_leadership/dyad_leadership_course/dyad_leadership_course.aspx?hkey=f6387317-48e4-44f1-b623-4b00fcba57ab&_zs=B3aFd1&_zl=cX2o8">Enroll online</a>. </p> <h3>Leadership Masterclass - Oct. 5-7, 2023</h3> <p> The WSMA Leadership Masterclass is an intensive three-day adaptive-learning course that examines the complex challenges faced by seasoned physician leaders and provides the tools necessary to solve them. This course will provide additional growth opportunities for physicians who have completed our Physician Leadership Course and have moved on to middle levels of management in their facilities. This activity has been approved for <em>AMA PRA Category 1 Credit</em>â„¢. <a href="[@]wsma/education/physician_leadership/leadership_masterclass/wsma/physician_leadership/leadership_masterclass/leadership_masterclass.aspx?hkey=b3ffc0a4-6cad-4a06-98aa-6e1a5e1e64b2&_zs=B3aFd1&_zl=dX2o8">Enroll online</a>. </p> <p> Thank you for your membership and your strong commitment to medicine in Washington state. Together we are making Washington the best place to practice medicine and receive care. </p> </div>2/3/2023 12:00:00 AM1/1/0001 12:00:00 AM
breaking-through-the-red-tapeBreaking Through the Red TapeLatest_NewsShared_Content/News/Latest_News/2023/breaking-through-the-red-tape<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img alt="January/February 2023 issue of WSMA Reports" src="/images/Newsletters/Reports/2023/january-february/wsma-jan-feb-2023-final-lr-cover-645x425px.jpeg" class="pull-right" /></div> <h5>February 2, 2023</h5> <h2>Breaking Through the Red Tape</h2> <p> By John Gallagher </p> <h5> <em>Members only; sign-in required.</em> </h5> <p> Fixing prior authorization will take time, starting with this year's legislative session. BY JOHN GALLAGHER Imagine a process that delayed needed care, relied on outdated technology, and drove up costs for physician practices and patients, yet in the vast majority of cases led to no change in the course of treatment. As it turns out, you don't have to imagine. That process exists: prior authorization. From the administrative burden it places on physicians to the harm it causes to patients, prior authorization has transformed from a process ostensibly established to reduce overuse of resources into one that diverts an enormous amount of time and resources better spent on patient care. "In the past 15 years, it's been getting worse and worse," says Katina Rue, DO, a family physician in Kennewick and president of WSMA. "Maybe there was a good reason when it began, but now it's snowballed into a giant entity. Physician practices are having to hire additional staff, retrain current staff, and pull physicians from patient care to deal with it." </p> <p> Indeed, a 2021 physician survey by the American Medical Association documented just how extreme the burden of prior authorization is on both physicians and patients. On average, the 1,000 physicians surveyed completed 41 prior authorizations every week, spending an average of two days on the process. Forty percent of physicians have staff who exclusively complete prior authorizations. Fully 88% of the physicians said that prior authorizations represented a high or extremely high burden. </p> <p> The 2021 survey underscores that the problem of prior authorizations is only getting worse. An AMA survey from 2017 found doctors completing four fewer prior authorizations a week and just over one-third of them with staff fully dedicated to the process. </p> <p> Recognizing the concerns of its members, the WSMA is making prior authorization reform its top priority in the 2023 Washington state legislative session. But reforming prior authorization won't be easy and it won't happen overnight. </p> <p> "This is going to be an ongoing priority," said Sean Graham, WSMA's director of government affairs. "We're in it for the long haul. We're committed to engage on this issue until we see meaningful improvement." </p> <h3>Opaque processes and antiquated technology</h3> <p> Every physician has stories to tell about how prior authorizations make caring for patients unnecessarily hard. To begin with, it's impossible to tell what will require prior authorization. Each carrier has its own rules and formularies, with the formularies sometimes changing at the start of the year. Physicians don't know what will require prior authorization until the insurance company rejects a prescription or request for a procedure, frustrating both physician and patient. </p> <p> For specialists, prior authorization is pretty much a given. Amish Dave, MD, a rheumatologist at Virginia Mason Franciscan Health, says that in his specialty, "most of our medications are biologics that are super expensive and almost all require prior authorization, not dissimilar to what oncologists and other specialists deal with." At this point, Dr. Dave says, even inexpensive medications are routinely subjected to prior authorization. </p> <p> Once a request is denied, the effort to get approval begins. The process is onerous enough, but it relies on outdated technology. At a time when medical systems are dependent upon electronic health records, prior authorization systems are dependent on fax machines. </p> <p> "It's bizarre that we're living in the 21st century and relying on faxes and hoping that they get it," says Dr. Dave. </p> <p> Because faxes can't be tracked the way an electronic exchange can, missed faxes and their attendant delays are all too common. "I can't tell you how many times faxes don't arrive for whatever reason," says Clinton Hauxwell, MD, a family physician at MultiCare in Spokane. </p> <p> The plans have a "peer-to-peer" process that, at least in theory, can match physicians with a knowledgeable colleague who can evaluate their case. However, the "peer-to-peer" part often fails to live up to its billing. </p> <p> "It's frequently somebody who knows less about the study than I do," says Dr. Hauxwell. "Not to say anything about the person on the other end of the line, but they're just reading the script." </p> <p> Dr. Dave says that his prior authorization questions about rheumatology cases are rarely handled by a rheumatologist. "I have had people with ANCA [anti-neutrophil cytoplasmic autoantibody] vasculitis, where they literally have an organ-threatening disease and I want to get them on rituximab," he says. "Instead of getting a peer, I get a pharmacist or a pediatric occupational medicine doctor who deals with disability cases and knows something about seminal trials. It's demeaning because you are talking to someone who has the power to deny the medicine you've been waiting weeks for, and then you talk to someone who is not even a peer." </p> <p> Indeed, prior authorization now treats every physician with the same level of suspicion, even if most physicians have their requests routinely approved. Essentially, health plans are casting the widest possible net to catch a few outliers. </p> <p> "My experience with prior authorization for imaging studies that require peer- to-peer review is that they always get approved because it's appropriate order," says Dr. Hauxwell. "But the time I and my staff spend is inordinate." </p> <h3>Risking patient safety and access to care while contributing to burnout</h3> <p> The waste of time and resources is just part of the problem with the current prior authorization system. The bigger one is the impact it has on patients and physicians. </p> <p> "My biggest concern is that due to its ever-increasing reach, it is actually now a patient safety issue," said Carrie Horwitch, MD, an internist at Virginia Mason Franciscan Health. "It is causing harm to patients by delaying care or even perhaps denying appropriate care." </p> <p> The AMA physician survey bears that observation out. Over a third of physicians reported that prior authorization led to a severe adverse event for a patient, while 24% indicated prior authorization led to a patient's hospitalization. </p> <p> As a primary care physician with a large HIV practice, Dr. Horwitch regularly runs into the prior authorization wall when she prescribes antiretrovirals for patients. "They are considered a specialty medication," she notes. "They are more expensive and typically a higher tier. I have experienced delays in getting approval when I need to start someone on medication or perhaps need to change someone to an antiretroviral that is better or safer for them. These are medications that shouldn't be delayed because they lead to better outcomes and reduced transmission." </p> <p> The problem is hardly confined to just HIV medications. "The other big area that many, many physicians and allied health professionals face with patients is diabetes," Dr. Horwitch says. "I think everyone has run into delayed or denied care, which could include insulin or the type we want to prescribe, or the new medications, which evidence shows may be better or safer for patients with multiple comorbidities than some of the older medications." </p> <p> Prior authorization denials hit some types of patients harder than others. A 2021 report on prior authorization from the Washington state Office of the Insurance Commissioner found that carriers reported a lower number of requests, approval rates, and response times for mental health-related codes. </p> <p> One frequent frustration is the tiering system for drugs. Sometimes patients fail on the first treatment, but instead of their physician being able to move them to a medication with a different method of action, they are denied access to that medication until they try another medication like the first failed treatment. </p> <p> "We know it didn't work for that first drug, and then they make someone suffer for no reason because you want them to try a cheaper medicine first," says Dr. Dave. Instead, the patient bears the financial cost of the failed second treatment, as well as the additional physical cost of the failed therapy before being able to get the right medication. </p> <p> Dr. Dave brings a unique perspective on prior authorization because for six years he used to do prior authorizations for a small pharmacy benefit management company. "There is a real role for prior authorization, and I understand that perspective," he says. Yet what he saw was that inappropriate use was a problem "less than 10% of the time," far smaller than the current prior authorization apparatus would justify. </p> <p> If anything, Dr. Dave says, physicians are trying to do right by their patients. "Most of the time, physicians are not trying to prescribe the wrong drug for their patients," he says. "They are not trying to prescribe something inferior or less effective just because it's cheaper." </p> <p> The constant battle just to do the right thing inevitably takes a toll on physicians. Jack Resneck Jr., MD, president of the AMA, has said that prior authorization is high on the list of what he calls "hassle factors" contributing to physician burnout. </p> <p> Dr. Dave agrees and points out that the burnout affects the relationship with patients. "One thing that is driving burnout for physicians is not just the increase in paperwork, but how the therapeutic alliance between patients and physicians is affected by these things," he says. "People think we are responsible for the delay in getting their treatment." </p> <p> Burnout only contributes to the physician shortage, particularly in primary care. Yet the remaining physicians find more and more of their time consumed by prior authorization requirements. </p> <p> "Now with physicians spending a large amount of time on prior authorizations instead of direct patient care, it's very directly impacting the access to patient care in Washington state," says Dr. Hauxwell. "It's time I could use to take care of patients. It adversely impacts patients' ability to have access to me, when I'm in a state that already has primary care access challenges." </p> <h3>Taking steps toward reform</h3> <p> Starting to tackle the many problems of prior authorization won't be easy. However, heading into legislative session, the WSMA is able to build on past successes, including a series of rulemakings from the insurance commissioner's office in 2015 and 2016, as well as legislation from 2020 that led to some reporting requirements on prior authorization practices. </p> <p> "We're making this our top priority for the 2023 legislative session," says WSMA's Graham. "We are looking to standardize prior authorization as broadly as we can at the state level. We are looking to reduce the administrative burden and expedite access to care for patients who need health care services." </p> <p> The WSMA is modeling its proposed legislation in part on a measure that was successfully passed last April in Michigan. Among the major components of the measure: </p> <ul> <li>Standardizingpriorauthorization requirements across state-regulated insurance carriers, mandating that insurance carriers utilize electronic portals, approve standard prior authorization requests within 48 hours, and approve expedited prior authorization requests within 24 hours.</li> <li>Promotingtransparencybyrequiring insurance carriers to post their prior authorization requirements and all relevant evidence and criteria online, as well as making it available to patients and physicians upon request.</li> <li>Ensuring insurance carriers are making informed decisions on prior authorization by requiring determinations to be made by a physician or physician assistant in the same specialty as the ordering physician or physician assistant.</li> <li>Prohibiting the use of prior authorizations for those services that are routinely approved at high rates, building on legislation the WSMA spearheaded in 2020 to compel annual reporting on insurance carriers' prior authorization practices.</li> </ul> <p> The Michigan legislation was the result of a three-year campaign. "We're hopeful that it won't take three years, but if that's what it takes, we're going to do it," says Graham. </p> <p> However, there is only so much that some legislation will be able to do. One major exception to any state-level reform that passes will be self-insured plans, which most large employers carry. Under the federal Employee Retirement Income Security Act, or ERISA, self- insured plans would be exempt from any changes to prior authorization requirements enacted in legislation. </p> <p> Efforts are also underway at the federal level to reform prior authorization. Last September, the House of Representatives passed a measure that would institute a number of changes for Medicare Advantage plans. The bill would establish an electronic process for prior authorization, forcing plans to move away from the antiquated fax and paper systems that many still require. The measure would also require Medicare Advantage plans to provide data to the Centers for Medicare and Medicaid Services on how frequently they require prior authorizations, as well as their rates of denials and approvals. </p> <p> In an era of intense political polarization, the measure had broad bipartisan support, with 326 votes in favor of passage. "I think our legislation is a straightforward fix that will make a huge difference for patients and for [physicians]," Rep. Suzan DelBene (D-Medina), the bill's sponsor, told the AMA. Even DelBene's family hasn't been spared the problem. A parent of a family member had to cancel scheduled surgery because they were unable to receive prior authorization in time. </p> <p> The WSMA has been actively supporting the federal effort, as well. Any reform that impacts Medicare could have wide-reaching implications. </p> <p> "There's a saying-as Medicare goes, so goes the world," says Jeb Shepard, WSMA's director of policy. "Traditional Medicare doesn't typically require prior authorization. What is really compelling here is that these are Medicare Advantage plans, so they are insurance carriers. The hope is that these potential new requirements on Medicare Advantage plans would be adopted by the broader carrier market, including those self- insured ERISA plans. That is simply a hope at the moment, and time will tell." </p> <p> Still, the momentum is moving toward change. </p> <p> "This legislation is the first step," Dr. Rue says of the Washington state measure. "This is a long process. It's going to be a stepwise approach that takes many years. The insurance companies have held the narrative for a long time. Now it's going to take physicians working with patient groups and others to help move this forward. Hopefully, right now health care is in a space where we're trusted by legislators and the public." </p> <p> <em>John Gallagher is a freelance writer specializing in health care.</em> </p> <p> <em>This article was featured in the January/February 2023 issue of WSMA Reports, WSMA's print magazine.</em> </p> </div>2/2/2023 12:00:00 AM1/1/0001 12:00:00 AM
your-voice-in-the-courtsYour Voice in the CourtsLatest_NewsShared_Content/News/Latest_News/2023/your-voice-in-the-courts<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img alt="January/February 2023 issue of WSMA Reports" src="/images/Newsletters/Reports/2023/january-february/wsma-jan-feb-2023-final-lr-cover-645x425px.jpeg" class="pull-right" /></div> <h5>February 1, 2023</h5> <h2>Your Voice in the Courts</h2> <p>By Graham Short</p> <h5> <em>Members only; sign-in required.</em> </h5> <p> A health insurer ignores a third- party network contract and pays a physician a far lower amount than negotiated by the physician with the network. The physician, following the provisions of their network contract, bills the patient for the difference between their agreed-upon rate and the lower amount. After receiving the balance bill, the patient appeals to the insurer, disputing the charge. In response, the insurer states that the physician who provided the medical service had agreed to the “discounted” fee for said service—when no such agreement had taken place. </p> <p> It’s a crafty if distressing two-step, with both the patient and the physician on the receiving end of the insurer’s deception. The physician is left with little recourse in recouping the agreed-upon charges, and the patient faces a nightmare of red tape and a damaged relationship with their physician. </p> <p> It’s also among the alleged transgressions at the heart of a multi- million-dollar class-action lawsuit filed by Cigna patients against the health insurer Cigna and involving the third-party MultiPlan Network. Recently joining the lawsuit as additional plaintiffs are the American Medical Association, the Medical Society of New Jersey, and the WSMA (one of the physician plaintiffs is from Washington state). The associations believe the insurer’s deceptive practices are “riddled with conflicts of interest and manipulations that routinely shortchanged payments to MultiPlan Network physicians and interfered with the patient-physician relationship,” as AMA President Jack Resneck Jr., MD, laid out in a statement. </p> <p> Calling out Cigna for its “sham network and physician underpayment,” WSMA President Katina Rue, DO, clarifies the bottom line for physicians: “This goes against the care we want to provide in our communities, with truly adequate networks and physicians who are able to keep their practices viable to serve our patients.” </p> <p> Given the number of MultiPlan contracts with physicians and health professionals (1.2 million nationwide), the number of Cigna’s insureds in commercial plans (more than 17 million), and the substantial difference between MultiPlan rates and what Cigna pays, some WSMA members will likely have a direct and meaningful financial stake in the outcome of this case. </p> <p> For all physicians, the case is important as it promotes transparency about medical service payment pricing and pushes back against insurer communications to insureds that interfere with the patient- physician relationship. </p> <h3>Your best defense</h3> <p> Legal advocacy is one of the most important advocacy arenas where organized medicine protects your interests. It’s also one of the less visible, often obscured by difficult or theoretical legal principles or simply hard to report on due to cases sometimes taking years to play out, as will likely be the case in the Cigna suit. </p> <p> “Typically our involvement is via an amicus brief ‘friend of the court’ brief; however, at times we will pursue an issue with a direct lawsuit,” says WSMA CEO Jennifer Hanscom. The through-line for all of WSMA’s legal advocacy is to look at each case “through the lens of its impact on the medical profession,” she says. </p> <p> From physician payment issues, medical staff privileges, medical liability issues, peer review and scope-of- practice matters, litigation is sometimes crucial to ensuring your ability to practice good medicine and protect your relationship with your patients. </p> <p> “We represent physicians in all spaces, including in the courts,” says Dr. Rue. </p> <p> Increasingly, the focus of legal challenges includes protecting physicians from insurer misbehavior, including issues regarding physician payments. The WSMA’s participation in the Cigna lawsuit is being underwritten by the AMA Litigation Center and reflects the increasing attention given by both the AMA and the WSMA on challenging egregious behaviors of health insurers. </p> <h3>An imbalanced billing ban</h3> <p> The Cigna suit isn’t the only legal challenge currently supported by the WSMA, the AMA, and others in organized medicine where health insurer misbehavior—and physician payment—is the overriding concern. </p> <p> The WSMA has joined with other state medical and medical specialty associations in signing on to an amicus brief supporting a Texas Medical Association lawsuit filed in September 2022 challenging the independent dispute resolution provisions of the No Surprises Act, the federal balance billing legislation passed in 2020. </p> <p> The brief, filed by the Physicians Advocacy Institute, supports TMA’s legal challenge, which alleges that federal regulators, when issuing a final rule implementing the independent dispute resolution provisions, violated the No Surprises Act by giving preference to the “qualifying payment amount,” which unfairly favors insurers when settling payment disputes between physicians and payers. This flawed approach was struck down by the Eastern District of Texas earlier last year before federal regulators sidestepped the court’s decision in the final rule. </p> <p> WSMA Director of Government Affairs Sean Graham connects the dots, saying “If carriers are allowed to reimburse physicians as they see fit, they won’t have natural incentives to contract at reasonable terms. </p> <p> “We’ve heard from numerous physician organizations in recent years who have had increasing difficulties contracting with carriers. There’s no doubt that the implementation of the No Surprise Act has decreased incentives for carriers to contract—exactly as we’d signaled to lawmakers that it would,” says Graham. </p> <p> If allowed to stand, the federal regulators’ approach will encourage even more health care consolidation and give insurers an unfair advantage contracting with physicians. “We’ll see further narrowing of already narrow, insurer- built physician networks,” raising serious concerns about patients’ ability to access affordable specialty care, says Dr. Rue. </p> <p> TMA’s lawsuit and the supporting amicus brief do not challenge the No Surprises Act’s critical patient protections, which went into effect in January of 2022. </p> <p> The TMA challenge is ongoing, but the WSMA is it for the long haul. “We are staying attuned to how federal and state legislation impacts contracting behavior and we will use the courts as appropriate to address unfair contracting practices or misbehavior on the part of the carrier community,” says Hanscom. </p> <h3>A promise of good faith</h3> <p> The crux of both the Cigna and No Surprises Act legal actions is increasing transparency in how insurance carriers reimburse physicians. “Sunshine is a powerful disinfectant. We’re hoping that forcing carriers to be more open with their payment methodologies will result in reasonable reimbursement for physicians,” says Graham. </p> <p> “Physicians and medical groups negotiate in good faith with carriers,” says Hanscom. “Patients and physicians have a right to expect health insurers to uphold their promise to provide fair and accurate payment for medical services.” </p> <p> Regardless of the outcome, members can count on the WSMA to continue to voice our opinion on legal matters important to the physician profession and our patients. </p> <p> “It’s part of what we do,” says Dr. Rue. “We stand up for medical practice, physicians, and patients.” </p> <p> <em>Graham Short is WSMA’s director of communications.</em> </p> <p> <em>This article was featured in the January/February 2023 issue of WSMA Reports, WSMA's print magazine.</em> </p> </div>2/1/2023 12:00:00 AM1/1/0001 12:00:00 AM
2023-legislative-session-update-previewing-this-fridays-legislative-summit2023 Legislative Session Update: Previewing this Friday's Legislative SummitLatest_NewsShared_Content/News/Latest_News/2023/2023-legislative-session-update-previewing-this-fridays-legislative-summit<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><a href="https://vimeo.com/793969734"><img alt="WSMA Legislative Update: January 30, 2023 logo" src="/images/Newsletters/latest-news/2023/jan/legislative-update-wk-4.png" /></a> </div> <h5>January 31, 2023</h5> <h2>2023 Legislative Session Update: Previewing this Friday's Legislative Summit</h2> <p>WSMA Director of Government Affairs Sean Graham on what to expect at our first in-person Legislative Summit since 2020, this Friday, Feb. 3, in Olympia. <a href="https://vimeo.com/793969734">Watch the video</a> and <a href="https://wsma.org/wsma/events/legislative_summit/wsma/events/wsma_legislative_summit/Legislative_Summit.aspx?hkey=795731a5-79ba-45b0-b78b-b9dfbfc336e5&_zs=B3aFd1&_zl=rqOn8">register for the Summit</a>. The event is free for WSMA members!</p> </div>1/31/2023 12:00:00 AM1/1/0001 12:00:00 AM
one-resolution-many-lessonsOne Resolution, Many LessonsLatest_NewsShared_Content/News/Latest_News/2023/one-resolution-many-lessons<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img alt="Heartbeat: Dale Reisner, MD graphic" src="/images/Newsletters/Reports/2023/january-february/heartbeat-website-image-reisner-645x425px.png" class="pull-right" /></div> <h5>January 31, 2023</h5> <h2>One Resolution, Many Lessons</h2> <p> By Dale Reisner, MD </p> <p> At the recent WSMA House of Delegates annual meeting, I was reflecting on an important resolution that I helped bring to the House in 2011. For the past 30 years, I've served as a delegate in the WSMA House of Delegates representing the Washington State Obstetrical Association as a maternal fetal medicine specialist with a focus on OB-GYN quality and safety. </p> <p> The rate of maternal mortality has been increasing in the U.S. over the past three decades, in contrast to stable or falling rates in most other industrialized nations. In 2010, pregnancy-related mortality was the 10th leading cause of death for reproductive- aged women in the U.S. For years, the Washington State Department of Health had an ad hoc maternal mortality review process using only information from death certificates and linked birth certificates. A small group of volunteer physicians and several Department of Health staff reviewed these deaths until 2009. With the market recession of 2009, those staff needed to stop any work that wasn't in statute and the review process was discontinued. </p> <p> By the summer of 2011, several OB-GYNs decided a resolution should go to the WSMA House of Delegates requesting support for legislation for peer-protected, more robust maternal mortality reviews. In a cozy cafe, fueled by coffee and wood- fired bagels, two of us polished a draft resolution to take to the House of Delegates meeting that fall. At the meeting, the resolution sparked discussion during the reference committee hearing and on the floor of the House of Delegates that was positive overall, although some questioned if the resolution was too specialty-specific (a consideration for all resolutions). Someone noted that everyone there at the meeting at some point had a mother-effectively highlighting the importance and universality of the impact of maternal mortality. The resolution was passed with a referral to the WSMA Executive Committee. </p> <p> Frustratingly, there was no action on the resolution in 2012. In fact, it wasn't until December 2015 when Sean Graham, clever WSMA lobbyist, identified a state senator who would strongly support maternal mortality review legislation. Support from the Washington State Hospital Association was important since hospitals would be asked for medical records in these cases. The Washington Section of the American College of Obstetricians and Gynecologists and the WSMA actively supported the bill. The original fiscal note attached was larger than necessary and with support from the state public health officer the fiscal note was right-sized. Supportive testimony was provided to both the Senate and the House of Representatives. Amazingly, the bill passed both chambers unanimously in February 2016 and became law that June. </p> <p> The original bill was to sunset in 2020. A follow- up bill was passed in April 2019 without a sunset clause. We have learned so much from the initial years reviewed (the report is publicly available) as well as from the ongoing review work identifying opportunities to improve outcomes. </p> <p> For WSMA members, the lessons from this experience are many. Most importantly, it takes a village to achieve success. Be patient if your first attempt at a resolution isn't successful or if your resolution gets referred instead of passed. It is not forgotten. If needed, try again, revise it based on input, and reach out to other stakeholders. WSMA staff are incredible and are available as resources for any member with questions! </p> <p> <em>Dale Reisner, MD, is a maternal-fetal medicine specialist at Swedish Medical Center in Seattle and WSMA past-president (2013-2014).</em> </p> <p> <em>This article was featured in the January/February 2023 issue of WSMA Reports, WSMA's print magazine.</em> </p> </div>1/31/2023 12:00:00 AM1/1/0001 12:00:00 AM
updated-washington-practitioner-application-supports-physician-well-beingUpdated Washington Practitioner Application Supports Physician Well-BeingLatest_NewsShared_Content/News/Membership_Memo/2023/january-27/updated-washington-practitioner-application-supports-physician-well-being<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/january/smiling-docs-645x425px.jpeg" class="pull-right" alt="smiling doctors" /></div> <h5>January 27, 2023</h5> <h2>Updated Licensing and Credentialing Applications Support Physician Well-Being</h2> <p>The WSMA is pleased to report that physicians and other licensed practitioners will now benefit from newly updated licensing and credentialing forms in Washington state. These widely used forms have been revised with input from the physician community, and reflect a growing awareness of the barriers to wellness that medical licensing and credentialing insurance applications were creating for physicians and practitioners. </p> <h3>Updated Washington Practitioner Application </h3> <p>This month, a streamlined <a href="https://www.wamss.org/resources/washington-credentialing-standardization-group/">Washington Practitioner Application</a> was introduced. The WPA is a standardized application that is accepted by most physician organizations, hospitals, and health plans and throughout the state. Changes to the application include:</p> <ul> <li>Updated attestation question regarding a practitioner's physical and mental health conditions. After years of discussions and input from numerous organizations, the credentialing committee overseeing the form revisions settled on a more streamlined question that still meets regulatory agency requirements to inquire about a practitioner's mental health status.</li> </ul> <ul> <li>A new section that asks for contact details for the monitoring program the practitioner is enrolled in but does not ask for any details around the condition or circumstances that led to being admitted into the monitoring program or the practitioner's current status with the monitoring program. This ensures that no practitioner PHI ends up on the WPA.</li> </ul> <h3>Washington licensing applications newly updated</h3> <p>The Washington Medical Commission has updated its <a href="https://wmc.wa.gov/licensing/applications-and-forms">licensing questions</a> to remove potentially invasive or stigmatizing language around mental health. The commission changed the question to an attestation and provided information about the Washington Physicians Health Program. These new updates follow changes in 2019 removing the requirement for applicants to disclose mental health or substance use disorder information resulting from new "safe haven" provisions. </p> <p>The WSMA gives special thanks to Washington Physicians Health Program Executive Medical Director Chris Bundy, MD, MPH, a strong physician advocate who helped provide guidance to both the Washington Medical Commission and the credentialing standardization committee on the changes to these forms.</p> <p>These combined changes represent significant progress in decreasing barriers to help-seeking for physicians and physician assistants in our state and furthers WSMA's vision to make Washington the best place to practice medicine and receive care.</p> </div>1/27/2023 12:00:00 AM1/1/0001 12:00:00 AM
wsma-advocacy-critical-to-removal-of-buprenorphine-prescribing-barriersWSMA Advocacy Critical to Removal of Buprenorphine Prescribing BarriersLatest_NewsShared_Content/News/Membership_Memo/2023/january-27/wsma-advocacy-critical-to-removal-of-buprenorphine-prescribing-barriers<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/january/buprenorphine-butrans10mcg-645px.jpeg" class="pull-right" alt="Butrans packets" /></div> <h5>January 27, 2023</h5> <h2>WSMA Advocacy Critical to Removal of Buprenorphine Prescribing Barriers </h2> <p>The passage of the omnibus spending package in December included a significant policy priority of the WSMA and addiction treatment professionals: a provision to remove federal barriers to medications for opioid use disorder and increase access to life-saving treatment that prevents overdoses and supports recovery.</p> <h3>About the Mainstreaming Addiction Treatment (MAT) Act</h3> <p>The Consolidated Appropriations Act for 2023 included key provisions from the Mainstreaming Addiction Treatment Act (H.R. 1384/S. 445), legislation supported by the WSMA intended to address America's worsening overdose crisis. The MAT Act:</p> <ul> <li>Removes the X-Waiver registration requirement, so all physicians and nonphysician practitioners with a standard controlled medication license can prescribe buprenorphine for opioid use disorder just as they prescribe medications for other chronic conditions.</li> <li>Removes the patient limits for prescribing buprenorphine for opioid use disorder.</li> <li>Removes the special Drug Enforcement Administration "X" prescribing number. Physicians can use their standard DEA controlled substance license number to prescribe buprenorphine for opioid use disorder.</li> <li>Removes the counseling referral and ancillary services requirement.</li> <li>Removes the X-Waiver training requirement.</li> <li>Removes the list of health care practitioners who can prescribe buprenorphine for opioid use disorder.</li> </ul> <p>See <a href="https://drive.google.com/file/d/1OwOAvy3oEs5DUtKAToS8irT4ZWApdezV/view">this brief for details</a> on these provisions.</p> <h3>WSMA's critical early leadership and support</h3> <p>The WSMA and a coalition of Washington stakeholders played a critical role in getting the MAT Act the attention it deserved at the federal level. Many stakeholders, including academic institutions, law enforcement, and other medical and recovery associations, signed on in support thanks to WSMA's early leadership on the policy, giving Washington state the broadest coalition of state-based organizations supporting the MAT Act.</p> <p>This state coalition was pivotal in gaining federal support for the bill, in particular from the many Washington state lawmakers in Congress who have an outsized influence on health policy, including Sen. Patty Murray, Rep. Cathy McMorris Rodgers, and Rep. Kim Schrier, as well as Washington's key party leaders, Rep. Suzan DelBene, Rep. Pramila Jayapal, and Rep. Derek Kilmer, who have significant influence on legislation that passes the House. We are grateful to these lawmakers, each of whom supported and prioritized the MAT Act because they knew that it was important for physicians and health care professionals in the state.</p> <p>The WSMA is especially grateful for the leadership and advocacy of Lucinda Grande, MD, Olympia addiction medicine physician, who authored Resolution C-15 on behalf of the Thurston-Mason County Medical Society, which called on the WSMA to support federal efforts to eliminate the buprenorphine waiver requirement. The resolution was passed by the 2019 WSMA House of Delegates and provided the policy underpinning for WSMA's advocacy on the issue.</p> <h3>Resources for prescribing buprenorphine</h3> <p>The Substance Abuse and Mental Health Services Administration has developed a <a href="https://www.samhsa.gov/sites/default/files/quick-start-guide.pdf" target="_blank" rel="noreferrer">buprenorphine quick start guide</a> and <a href="https://www.samhsa.gov/sites/default/files/quick-start-pocket.pdf" target="_blank" rel="noreferrer">pocket guide</a> for all physicians and practitioners seeking to prescribe buprenorphine. We encourage physicians in active practice to familiarize themselves with this guidance and consider, when appropriate, prescribing buprenorphine to prevent painful withdrawal symptoms associated with opioid use disorder, just as you would prescribe medications for other chronic conditions.</p> </div>1/27/2023 12:00:00 AM1/1/0001 12:00:00 AM
wsma-continues-engagement-with-the-states-health-care-cost-transparency-boardWSMA Continues Engagement with the State's Health Care Cost Transparency BoardLatest_NewsShared_Content/News/Membership_Memo/2023/january-27/wsma-continues-engagement-with-the-states-health-care-cost-transparency-board<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2023/january/stethoscope-dollar-sign-645x425px.jpeg" class="pull-right" alt="stethoscope in the shape of a dollar sign" /></div> <h5>January 27, 2023</h5> <h2>WSMA Continues Engagement with the State's Health Care Cost Transparency Board </h2> <p>The WSMA has monitored and participated in the work of the state's <a href="https://wsma.org/wsma/advocacy/health_care_cost_transparency/wsma/advocacy/health_care_cost_transparency/health_care_cost_transparency.aspx?hkey=a9ff53b5-1080-43e7-9b48-1fec039ce9c6">Health Care Cost Transparency Board</a> throughout 2022, attending meetings and submitting comment letters when warranted. The WSMA continues to collaborate, primarily with the Washington State Hospital Association, to submit feedback reflecting our concerns over various aspects of the board and its established benchmarks.</p> <p>Last month, the WSMA worked with WSHA to submit a <a href="javascript://[Uploaded files/News and Publications/newsletters/2023/hcctb-annual-report-comment-letter-final.pdf]">comment letter</a> on the board's first annual report, which was submitted to the Legislature in advance of the 2023 legislative session, highlighting our shared concerns not reflected in the report. More recently, the WSMA partnered with WSHA, the Association of Washington Health Plans, and the Washington State Medical Group Management Association to submit a <a href="javascript://[Uploaded files/News and Publications/newsletters/2023/hcctb-inflation-letter.pdf]">comment letter</a> to the board over concerns with inflation, suggesting a more meaningful and achievable benchmark considering the economic challenges we are facing.</p> <p>The WSMA will continue to engage with the board and other stakeholders and will keep members apprised of developments.</p> </div>1/27/2023 12:00:00 AM1/1/0001 12:00:00 AM
2023-legislative-session-update-week-32023 Legislative Session Update: Week 3Latest_NewsShared_Content/News/Latest_News/2023/2023-legislative-session-update-week-3<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><a href="https://vimeo.com/791757558"><img src="/images/Newsletters/latest-news/2023/jan/legislative-update-week-3-2023.png" alt="Legislative Update logo for the week of January 23, 2023" /></a> </div> <h5>January 23, 2023</h5> <h2>2023 Legislative Session Update: Week 3</h2> <p>WSMA Associate Director of Legislative and Political Affairs Alex Wehinger gives an update on bills related to abortion access scheduled for hearings in the Legislature this week. <a href="https://vimeo.com/791757558">Watch the video</a>.</p> <h3>Join us at the WSMA Legislative Summit for a panel discussion on abortion in Washington</h3> <p>Sen. Karen Keiser (D-Des Moines); WSMA President-Elect and OB-GYN Nari Hesmati, MD; and Planned Parenthood State Director Courtney Normand will join us at the Legislative Summit next Friday, Feb. 3 in Olympia for a panel discussion on the state of abortion in Washington. The meeting is free for WSMA members - <a href="https://wsma.org/wsma/events/legislative_summit/wsma/events/wsma_legislative_summit/Legislative_Summit.aspx?hkey=795731a5-79ba-45b0-b78b-b9dfbfc336e5">register today</a>.</p> </div>1/23/2023 12:00:00 AM1/1/0001 12:00:00 AM
Weekly_rounds_january_20_2023_new_washington_practitioner_application_supports_physician_wellnessWeekly Rounds: January 20, 2023 - New Washington Practitioner Application Supports Physician WellnesLatest_NewsShared_Content/News/Weekly_Rounds/2023/Weekly_rounds_january_20_2023_new_washington_practitioner_application_supports_physician_wellness<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Weekly%20Rounds/Weekly-Rounds-Article-Graphic-2022-645x425px.png" class="pull-right" alt="Weekly Rounds logo" /></div> <h5>January 20, 2023</h5> <h2>Updated Washington Practitioner Application Supports Physician Well-Being</h2> <p>Jennifer Hanscom, CEO</p> <p>Last summer, the Physicians Foundation conducted a survey of physicians that focused on physicians' well-being and solutions needed to improve wellness. The survey called out that nearly four in 10 physicians were afraid or knew another physician who was fearful of seeking mental health care given questions asked in medical licensure and credentialing insurance applications.</p> <p>Thankfully, the Washington Medical Commission had the foresight to understand this barrier to wellness that medical licensing applications were creating. As a result, the commission updated language on the initial licensure application and renewal applications so that applicants no longer have to disclose mental health or substance use disorder information due to the new "safe haven" provisions. This happened in 2018 and was hailed as a vast improvement, as well as a meaningful and practical change toward eliminating barriers to wellness.</p> <p>But the work didn't stop there. Earlier this month, a newly streamlined <a href="https://www.wamss.org/resources/washington-credentialing-standardization-group/">Washington Practitioner Application</a> was released, with changes reflecting input from the physician community that will decrease barriers to seeking help.</p> <p>The WPA is a standardized application that is accepted by most physician organizations, hospitals, and health plans and throughout the state. Changes to the application include:</p> <ul> <li>Updated attestation question regarding a practitioner's physical and mental health conditions. After years of discussions and input from numerous organizations, the credentialing standardization committee overseeing the form revisions settled on a more streamlined question that still meets regulatory agency requirements to inquire about a practitioner's mental health status.</li> <li>A new section that asks for contact details for the monitoring program the practitioner is enrolled in but does not ask for any details around the condition or circumstances that led to being admitted into the monitoring program or the practitioner's current status with the monitoring program. This ensures that no practitioner's protected health information ends up on the WPA.</li> </ul> <p>The WSMA gives special thanks to Washington Physicians Health Program Executive Medical Director Chris Bundy, MD, a strong physician advocate who helped provide guidance to both the Washington Medical Commission and the credentialing standardization committee. These combined changes represent significant progress in decreasing barriers to help-seeking for physicians and physician assistants in our state and furthers WSMA's vision to make Washington the best place to practice medicine and receive care.</p> </div>1/20/2023 12:00:00 AM1/1/0001 12:00:00 AM
member-profile-michael-mike-brigoli-mdMember Profile: Michael 'Mike' Brigoli, MDLatest_NewsShared_Content/News/Latest_News/2023/member-profile-michael-mike-brigoli-md<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2023/january-february/member-profile-website-image-brigoli-645x425px.png" class="pull-right" alt="Mike Brigoli, MD photo" /></div> <h5>January 6, 2023</h5> <h2>Member Profile: Michael 'Mike' Brigoli, MD</h2> <p> <strong>Works at:</strong> University of Washington Palliative Medicine </p> <p> <strong>How long in practice: </strong>Since July 2022 </p> <p> <strong>Specialty:</strong> Hospice and palliative medicine fellow </p> <p> <strong>Why WSMA:</strong> The WSMA represents the opportunity to have a voice. Before becoming a physician, I was an Army medic and a firefighter and paramedic. As a first responder, I saw heartbreaking situations due to lack of access to care and lack of resources. The WSMA enables me to advocate for policies that make a difference for the most vulnerable members of our community. </p> <p> <strong>Proud moment in medicine:</strong> I come from humble beginnings, having spent part of my childhood homeless and in foster care. I am the oldest of 11 children in a blended family. I went to 12 different public schools from kindergarten to high school. I am from Hawaii, where indigenous Hawaiians make up 24% of the population, but only 4% of the physician workforce. As a native Hawaiian, I didn't think I could be successful with higher education. That is why getting into medical school at the age of 40 was an important milestone for me and my family. To do so, I left a career as a firefighter and paramedic. I didn't even have an undergraduate degree. Heading back to school meant the pressure of being a single-income family fell on my wife. I felt like matriculating meant her sacrifice was paying off and, even though it would take a while, there was light at the end of the tunnel. </p> <p> <strong>Top concerns in medicine: </strong>According to a pre-pandemic study from the Association of American Medical Colleges, we are facing a severe shortage of physicians across the country, as much as 124,000 by 2034. I worry that the pandemic has worsened those numbers exponentially. While medical school enrollment is up, our GME positions have been limited by federal budget legislation. It is time for a change. </p> <p> I am intimately familiar with the consequences of a physician shortage. My home in Hawaii had a physician deficit of 30% compared to what was needed to care for the community. As a result, the local emergency departments became much busier and so did our EMS agencies. When I picked up patients by ambulance, I would ask who their primary care physician was. They would give me the name of an emergency department physician. I would clarify by asking who wrote their prescriptions for their chronic conditions. Their answer did not change. </p> <p> The conditions that I saw then are getting worse. The most vulnerable in our communities will suffer the worst as a result. </p> <p> <strong>What inspires me in medicine:</strong> While we have made tremendous strides in our ability to provide medical interventions in the lives of our patients, I am inspired by the little things that the physicians around me do to make the lives of their patients better: The call to family at the end of the day to update them regarding a patient's condition; holding a patient's hand during a difficult conversation; taking extra time to ensure that all the patient's questions are answered and explained in a way that they understand. These acts of kindness are often done despite the pressure of having to see a full panel of patients, attend scheduled faculty meetings, and participate in teaching sessions for learners. </p> <p> <strong>Challenges to our profession: </strong>I am concerned that we have a public confidence issue. We have gone from a respect for the education and training that are required to practice medicine to a "I've done my own research" culture. I think there has been an erosion of trust for physicians and that will continue to be a challenge in the care of our patients. </p> <p> <strong>Why I wanted to become a physician: </strong>While working as a firefighter and paramedic, my district was so busy that in a 24-hour shift I would often be on the road for more than 14 hours. One day while taking a basic life support call, another 911 call came in for chest pain from my uncle's address. Since I was already on a call, the ambulance from the next town was dispatched, an additional 15-minute response time. My uncle had a myocardial infarction that day and did not survive. </p> <p> Because of our community's physician shortage, our emergency department was busier, and emergency medical services were inundated with patients who felt that ambulance transport might expedite their care in the ED. It was not a good situation. </p> <p> I often would visit high school health career pathway classes to discuss how I became a paramedic. While there, I would ask how many of them wanted to become physicians; knowing the need was severe. There were times that, in a class of 60 high school students who self-identified as wanting to pursue a health career, none would raise their hands. </p> <p> I began to feel guilty about asking teenagers to make a sacrifice that I had not made. I also felt challenged by not being able to help them achieve the goal of becoming a physician. That's when I realized that I had a passion to pursue medicine myself. That my passion was greater than the fear of leaving the fire department or the fear of not being smart enough to accomplish my goal. I didn't know any physicians who were former foster children and knew very little who were Native Hawaiian. What I did know, however, was the consequence of a physician shortage and that I wanted to be a part of the solution for my community. </p> <p> <strong>Why my specialty:</strong> My life experience with childhood homelessness, foster care, service in the Army, and time as a firefighter and paramedic allows me to understand how patients with serious life-limiting illnesses may feel they don't have many options for care. I love being able to explore who they are. Sometimes this leads to a revelation for patients about goals for their life. Based on these conversations, some patients opt not to limit the scope of their care and continue with aggressive care for the hope of a longer life. Others may opt to pursue comfort and time at home with their family, even if it means a shorter life. In either situation, the decision is made based on the values and life experience of the patient. </p> <p> I also spent two decades taking patients to the hospital, seeing the ravages of acute injury, and exacerbations of chronic illnesses. I love the opportunity to give patients the option and opportunity to avoid ED visits and hospital admissions. </p> <p> We are a specialty of "wonder." I wonder if there is more we can do to manage a patient's symptoms. I wonder what is most important for the patient and their family in light of their illness. I wonder what they are hoping for; what they are worried or concerned about. I sit in wonder of the amazing life stories that I get to hear about in the process of exploring the patient's narrative. </p> <p> <strong>If I weren't a doctor, I'd be: </strong>A firefighter and paramedic. It was amazing to be on the front lines for any major incident in a community. You meet people where they live and help them with what may be the worst day of their life. It was incredible to go from a motor vehicle accident directly to an out-of-hospital baby delivery. </p> <p> <strong>Top three leadership lessons: </strong> </p> <ol> <li>Get to know your team. There are so many opportunities for miscommunication that can cause friction between team members. Learning about who they are helps us to see their perspectives.</li> <li>Surround yourself with people who are good at what they do, then let them do it.</li> <li>Start by sharing the objective or mission and see what ideas the team has on how to accomplish it. This can be the best way to find solutions that we haven't thought about before.</li> </ol> <p> <strong>Best advice I ever got: </strong> The best advice I ever got was to find an activity that refreshed me and do that as often as life would allow. Something that I could do for hours on end with more energy than when I started. For me this was coaching my sons' club soccer team. This allowed me to spend time with my family and serve my community. We did travel tournaments and combined that with educational experiences. My oldest son eventually ended up attending a college that we toured while at an out-of-state tournament. </p> <p> Following this advice made interviews for residency, fellowship, and physician jobs so much easier, as well. It was simple to answer the "tell me about yourself" question. I knew what gave me energy and could talk about my family and community at length. It gave me a chance to show what I could do when motivated by something I was passionate about. </p> <p> The biggest benefit was that I knew what activities filled me and could schedule that activity when times get tough. My sons are older now and no longer play club soccer. I know that time with them and my wife fills me, though, and we make time to get together and do activities as much as we can. </p> <p> <strong>Spare time: </strong>My wife and I love to drive around the state and visit new locations. It's all about the food and scenery of the Pacific Northwest. We will sometimes pull up the reviews of restaurants, bakeries, or coffee shops for a town and plan a trip for the day. It's a great way to explore our new home. </p> <p> <strong>Hobbies:</strong> I love running and biking. I have done 10 marathons, three half-marathons, and a half Ironman triathlon. I have learned a lot about the ability to persevere toward a goal during my training and in races. No two races are the same and each offers its own challenges. </p> <p> <strong>Three goals for the year ahead:</strong> </p> <ol> <li>Find a post-fellowship job in palliative medicine.</li> <li>Spend as much of my free time as possible showing my appreciation to my family for the sacrifices they have made for this journey we are on.</li> <li>Schedule and complete another half-marathon.</li> </ol> <p> <strong>Something most people might not know about me:</strong> I attended and graduated from medical school with the son of a high school classmate. I am literally old enough to be the parent of my medical school classmates. It was during our orientation that I recognized my classmate's last name. We began talking and eventually I found out that his father graduated from the same high school I did. </p> <p> <strong>Pet peeves:</strong> Palliative medicine is not a destination. We are a specialty involved in the care of any patient with a serious life-limiting illness. I have often heard, "I don't think the patient is ready to be palliative." If they have a complex symptom management issue, could benefit from a goals-of-care discussion to align the multiple care teams with their goal, or have limited options for their care, we are here to help. For example, I wouldn't say "I don't think the patient is ready to be nephrology or cardiology." </p> <p> <strong>Recommended reading:</strong> "When Breath Becomes Air," by Paul Kalanithi. I have read and go back to passages in this book frequently because it helps me to remember the vulnerability we have in life as physicians and providers. Paul does an amazing job sharing his story. </p> <p> <em>This article was featured in the January/February 2023 issue of WSMA Reports, WSMA's print magazine.</em> </p> </div>1/6/2023 12:00:00 AM1/1/0001 12:00:00 AM
weekly-rounds-january-6-2023-a-new-year-a-new-chance-to-address-prior-authorizationWeekly Rounds: January 6, 2023 - A New Year, a New Chance to Address Prior AuthorizationLatest_NewsShared_Content/News/Weekly_Rounds/2023/weekly-rounds-january-6-2023-a-new-year-a-new-chance-to-address-prior-authorization<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Weekly%20Rounds/Weekly-Rounds-Article-Graphic-2022-645x425px.png" class="pull-right" alt="Weekly Rounds logo" /></div> <h5>January 6, 2023</h5> <h2>A New Year, a New Chance to Address Prior Authorization</h2> <p>Jennifer Hanscom, CEO</p> <p> Happy New Year! </p> <p> As I settled back to work after a two-week vacation, I saw the latest issue of WSMA Reports on my desk. The front cover certainly grabs your attention; no doubt the topic of prior authorization had many of you opening the issue to see just what the WSMA can do to address this burdensome barrier to care. </p> <p> "You can't fix what you don't measure," the old adage goes. Along those lines, in 2020 the WSMA successfully advocated for legislation requiring the state Office of the Insurance Commissioner to release an annual report on insurance carriers' prior authorization practices, with the first report due in 2021. In that first report, the OIC found there were numerous codes that were approved 100% of the time. In fact, of the 469 codes reported by carriers, 352 (or 75%) of the codes were approved 100% of the time. Widely used codes for colonoscopies and psychotherapy were approved 99% of the time. </p> <p> The 2021 report also showed that mental health and substance use disorder (MH-SUD) code requests faired poorer against medical surgical code requests (med-surg). Carriers reported a lower number of requests, approval rates, and response times for MH-SUD-related codes. Response times averaged around 174 hours for both inpatient and outpatient MH-SUD, compared to an average of 118 hours for inpatient and outpatient med-surg codes. </p> <p> Fast forward to the <a href="https://www.insurance.wa.gov/sites/default/files/documents/2022_health_plan_prior_authorization_report_0.pdf" target="_blank" rel="noreferrer">OIC's year-end 2022 report</a> just submitted to the Legislature on the eve of the 2023 legislative session, which shows the prevalence of prior authorization has continued to increase significantly in several areas. </p> <p> Comprising 2021 claims data from 14 of the state's largest health insurance carriers, the OIC report outlines prior authorization practices across a number of service categories. "Highlights" of the 2022 report include:</p> <ul> <li>For the codes where it's applied most often, carriers' usage of prior authorization increased substantially between 2020 and 2021, in some cases doubling. Among the codes where prior authorization is most frequently required, the average approval rate was 93.45%.</li> <li>Prior authorization for numerous codes was approved 100% of the time. Of the 486 distinct codes included in carriers' reporting, 416 (86%) were approved 100% of the time.</li> <li>As noted in the 2021 report, carriers' reported response times for prior authorization requests varies considerably by the type of service at issue, with determinations for mental and behavioral health services taking much longer than other services. This runs contrary to the state's mental health parity law, which generally requires comparable insurance coverage for mental and behavioral health services.</li> </ul> <p> The report findings track with the experiences of WSMA members, who regularly rate frustration with prior authorization as their top priority for advocacy. </p> <p> Thankfully the WSMA has a champion on this issue in Rep. Tarra Simmons (D-Bremerton). The WSMA will be working with Rep. Simmons to bring forward legislation in the 2023 session to address issues associated with prior authorization, including limiting its utilization where it's approved at exceedingly high rates and standardizing requirements across insurance carriers. </p> <p> The 2023 session is set to convene on Jan. 9 and is expected to run to April 23. </p> <p> In the January/February issue of <em>WSMA Reports</em>, you'll read more about the WSMA's work in Olympia and the issues we will be engaged on. If you'd like more regular updates, be sure to subscribe to WSMA's Outreach and Advocacy Report, which is emailed to subscribers every Friday throughout the session (to subscribe, simply email Alex Wehinger at <a href="mailto:alex@wsma.org">alex@wsma.org</a>). We will of course keep you updated via our other communications channels. And for those of you who want to engage d irectly in our advocacy work, join us Feb. 3 in Olympia for the WSMA Legislative Summit. You can <a href="[@]wsma/events/legislative_summit/wsma/events/wsma_legislative_summit/Legislative_Summit.aspx?hkey=795731a5-79ba-45b0-b78b-b9dfbfc336e5&_zs=B3aFd1&_zl=scDl8">register here</a>.</p> </div>1/6/2023 12:00:00 AM1/1/0001 12:00:00 AM
governor-releases-budget-proposal-for-2023-2025-bienniumGovernor Releases Budget Proposal for 2023-2025 BienniumLatest_NewsShared_Content/News/Membership_Memo/2022/december-23/governor-releases-budget-proposal-for-2023-2025-biennium<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/december/spring-wa-capitol-645x425px.jpeg" class="pull-right" alt="Washington state capitol building in spring" /></div> <h5>December 23, 2022</h5> <h2>Governor Releases Budget Proposal for 2023-2025 Biennium</h2> <p>Last week Gov. Jay Inslee released his budget proposal, kicking off negotiations around the next two-year state spending plan and signaling the approach of the legislative session that begins on Jan. 9. Spanning $70 billion in spending, the governor's proposal would increase state spending by around 12% and does not rely on new tax increases. </p> <p>In announcing his budget, Inslee highlighted proposed investments in housing and homelessness, climate change, and behavioral health, including $50 million to address the opioid epidemic-including funding to support the <a href="https://wsma.org/wsma/resources/opioids/better_prescribing_better_treatment/wsma/resources/opioids/better_prescribing_better_treatment/better_prescribing_better_treatment.aspx?hkey=b6fb0ec0-8bc2-4e53-bf4c-9f148599cbeb">Better Prescribing, Better Treatment</a> program, the joint initiative of the WSMA and the Washington State Hospital Association to inform physicians' prescribing patterns.</p> <p>The budget aligns with other WSMA priorities, including proposed funding and associated policies to ensure access to abortion services and to address gun violence, and proposed investments in our health care workforce, most notably the creation of 400 new nursing slots and a public health degree program at Washington State University.</p> <p>Investments are also proposed to support access to health care coverage for undocumented immigrants ($19 million); fund public health and winding down COVID-19 services ($120 million); and to increase capacity in the health care system by raising Medicaid rates for long-term care facilities and facilitating discharge of patients from hospital settings (more than $300 million across multiple appropriations). </p> <p>State revenues have remained strong in the wake of the COVID-19 pandemic, yielding around $1.5 billion more than was expected through 2025. Collective bargaining agreements the governor recently struck with state employee unions consumed some of that capacity, however, limiting investments in new programs. One of those agreements stipulates that for care delivered in state employee health plans, ARNPs will be reimbursed at the same rate as physicians. The WSMA has opposed this policy in recent years when it's been proposed as legislation and the collective bargaining agreement represents a potential end-run around the Legislature.</p> <p>While Gov. Inslee's budget does not raise taxes, it does propose new spending in the form of bonding capacity to support $4 billion in investments in housing and to address homelessness. This would require a referendum to voters. The budget also relies on revenue from the state capital gains tax that was adopted in the 2021 session and is currently the subject of a legal challenge pending the state Supreme Court.</p> <p>WSMA's top budget priority for the 2023-25 state fiscal cycle is an across-the-board rate increase for professional services delivered in the Medicaid program. Increasing Medicaid rates to Medicare levels would cost the state an estimated $134 million annually, leveraging $290 million in federal funds for a total annual investment of $423 million. While this funding was not included in the governor's budget, we will be advocating for its inclusion in legislative spending plans, which will likely be released in early April and finalized before session is scheduled to adjourn on April 26.</p> <p>If you're interested in staying plugged in to the WSMA's work in Olympia, you <a href="[@]wsma/events/legislative_summit/wsma/events/wsma_legislative_summit/legislative_summit.aspx?hkey=795731a5-79ba-45b0-b78b-b9dfbfc336e5">can register for the 2023 Legislative Summit</a> taking place on Feb. 3, and receive our weekly Outreach and Advocacy Report by emailing WSMA's Legislative Coordinator Chelsea Thumberg at <a href="mailto:chelsea@wsma.org">chelsea@wsma.org</a>. </p> </div>12/23/2022 12:00:00 AM1/1/0001 12:00:00 AM
omnibus-bill-in-congress-includes-2-percent-medicare-physician-payment-cutOmnibus Bill in Congress Includes 2% Medicare Physician Payment CutLatest_NewsShared_Content/News/Membership_Memo/2022/december-23/omnibus-bill-in-congress-includes-2-percent-medicare-physician-payment-cut<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/december/medicare-barcode-645px.jpeg" class="pull-right" alt="Medicare barcode" /></div> <h5>December 23, 2022</h5> <h2>Omnibus Bill in Congress Includes 2% Medicare Physician Payment Cut</h2> <p>Despite calls from the American Medical Association, the WSMA, and the physician community, the must-pass omnibus spending deal struck by congressional leaders this week will apply a 2% cut in 2023 and at least a 1.25% cut in 2024 to physician Medicare reimbursements.</p> <p>As the WSMA recently <a href="https://wsma.org/Shared_Content/News/Membership_Memo/2022/november-23/in-new-survey-practices-continue-to-grapple-with-economic-hardship?_zs=Pimae1&_zl=dV3k8">reported to our members</a> and to <a href="https://wsma.org/Shared_Content/News/Press_Release/2022/access-to-care-will-continue-to-diminish-in-washington-without-intervention-new-survey-reveals.aspx?WebsiteKey=c182ff6d-1438-4899-abc5-614681b54927">the media and the public</a>, physician practices across the state are grappling with the economic hardship caused by workforce shortages and inflation. While the physician community was successful in staving off as much as an 8.5% cut in 2023, the WSMA is still deeply concerned about the impact a 2% reduction in Medicare reimbursement will have during a difficult time for practices and on the heels of a highly disruptive pandemic.</p> <p>When adjusted for inflation, Medicare physician payments dropped by 22% from 2001 to 2021. With additional cuts in 2023, physicians simply cannot afford to operate under the current payment system. This latest disappointing news from Congress underscores the need for a comprehensive rethink of the Medicare payment system. The WSMA will be joining the AMA in seeking to reform the Medicare payment system in 2023 based on the principles of simplicity, relevance, alignment, and predictability. <a href="[@]wsma/advocacy/medicare_payment_reform/wsma/advocacy/medicare_payment_reform/medicare_payment_reform.aspx?hkey=d1a48c1c-af7b-4680-bd55-967338f3c977">Learn more about our plan for reforming Medicare</a>.</p> </div>12/23/2022 12:00:00 AM1/1/0001 12:00:00 AM
wsma-economic-impact-survey-of-physician-practicesWSMA Economic Impact Survey of Physician PracticesLatest_NewsShared_Content/News/Latest_News/2022/wsma-economic-impact-survey-of-physician-practices<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/july/doc-patient-exam-room-645x425px.jpg" class="pull-right" alt="physician treating a patient" /></div> <h5>December 19, 2022</h5> <h2>WSMA Economic Impact Survey of Physician Practices</h2> <p>Over the last several years, the WSMA and Washington State Medical Group Management Association have periodically conducted surveys to better understand the economic challenges facing physicians, their practices, and patients resulting from COVID-19. Feedback has been vital to our advocacy at the state and federal levels as we secured regulatory and financial relief for medical practices. </p> <p>With the recission of COVID-19 proclamations and regulatory waivers and the 2023 legislative session on the horizon, the WSMA and the WSMGMA conducted a sixth survey to better understand how these issues have affected physicians and patients to inform our advocacy.</p> <p>Results from this latest round of surveying clearly demonstrate that inflation and workforce shortages, as well as the ongoing COVID-19 pandemic, are still adversely impacting outpatient physician practices, and hindering patient access to care across Washington. Respondents also note that administrative tasks, such as prior authorization remain burdensome to their practices and further strain their limited staffing resources.</p> <p>If actions are not taken to shore up the medical practice community, access to outpatient care in our state will be severely diminished over the next year. Patients will no longer be able to get care, at the right time, at the right place, creating even more pressure on our already overwhelmed hospitals.</p> <p>During the 2023 state legislative session, the WSMA will ask the Legislature to raise Medicaid rates to Medicare levels, as physician groups and practices overwhelmingly believe that doing so will help stabilize finances while maintaining access for current Medicaid panels and even increasing to include more patients. In addition, the WSMA will help introduce legislation to rein in insurance carrier prior authorization practices, which would also relieve staffing challenges currently felt by most of the medical practice community.</p> <p>Download the <a href="javascript://[Uploaded files/News and Publications/Latest News/2022/inflation-survey-final.pdf]">November 2022 practice economic survey results</a>.</p> <h3>About the respondents</h3> <p>Eighty-two physician practices responded, representing more than a thousand physicians and health care professionals that provide care to millions of Washingtonians.</p> <ul> <li>26% of survey respondents were solo practitioners.</li> <li>44% were in practices of 2-10 physicians and</li> <li>7% were in practices of 11-20 physicians.</li> <li>12% of respondents represented practices of 21-50 physicians, and</li> <li>11% represented practices with over 51 physicians.</li> </ul> <p>These represent smaller outpatient practices that are not affiliated with a hospital system and are often the only care provided in some communities, especially rural areas.</p> <h3>Medicaid patients </h3> <p>Most of these practices serve Medicaid patients (75%) in addition to commercial and Medicare patients.</p> <h3>Staffing shortages have led to practice closures and reduction in services</h3> <p>Regarding staffing, 89% of respondents said are having experiencing shortages. Of the respondents experiencing staffing shortages, 77% are experiencing challenges filling administrative staff positions, 75% are experiencing challenges filling medical assistant positions, 40% are having trouble filling nursing positions, and 33% are having trouble hiring physicians.</p> <p>Staffing shortages have meant 46% of practices have had to reduce patience access. Almost 40% have had to reduce their office hours, as well as services and treatments offered to patients. One respondent noted that <em>"We will most likely close our Walla Walla office by the end of the year. We understand we are the only eye surgeon serving the low income."</em> If current staffing and financial trends continue, 51% of practices aren't confident they'll be able to provide the same level of patient access a year from now.</p> <p>Other strategies to mitigate staffing challenges:</p> <ul> <li><em>Delayed well child care and chronic disease management.</em></li> <li><em>Our waiting room is now where we see patients.</em></li> <li><em>Limited number of new patients.</em></li> <li><em>Closed on Friday, longer wait times for patients.</em></li> <li><em>Delays in care and decreased access to services.</em></li> <li><em>Cut back on clinic based testing and closed satellite office.</em></li> <li><em>Increased workloads for staff which is causing burnout.</em></li> </ul> <h3>Inflation is impacting almost all practices </h3> <p>Inflation is impacting practices: 51% of respondents said that inflation has had a significant impact on their practice, while 44% said that inflation has had some impact on their practice. Of those impacted by inflation, 89% noted the rising cost of labor. To mitigate the impact of inflation, over 30% of practices have reduced office hours, patient access, and services and treatments offered to patients.</p> <p>What physician groups said about inflation:</p> <ul> <li><em>Our staff are getting lured away for high cash compensation and forsaking our generous benefits package to keep up with their short-term financial stressors of rising rents/transportation/food.</em></li> <li><em>Supply chain disruptions, we can't get flu test kits, off and on shortages or syringes or medications.</em></li> <li><em>Payroll taxes, office equipment, supplies, malpractice insurance, property upkeep, and business taxes. Just to mention a few. I currently have my business for sale, it's become too much for a private practice to stay in business.</em></li> <li><em>Inflation is going up. Payment from insurers is going down or staying flat. This trajectory in not sustainable to recruit and retain physicians to our specialty in the long term.</em></li> <li><em>We raised our rates where we were able to, but insurance payments have not kept pace with inflation.</em></li> <li><em>Stopped services where reimbursement did not keep up with cost of goods used.</em></li> <li><em>Work harder and longer. Seeing 30+ patients per day per doctor at times.</em></li> <li><em>Limiting Medicaid patients.</em></li> </ul> <h3>Ideally, practices should have 18 weeks' (roughly four months) worth of days "cash on hand"</h3> <p>Defined as the number of days their organization can pay its operating expenses with current cash available, 93% of practices responded with having less than 4 months days cash on hand. Over half of practices report that their days cash on hand is down since November of 2021. Of those who reported that their cash on hand was down, 83% attributed it to staffing shortage or inflation.</p> <h3>Access to care for Medicaid patients is threatened</h3> <p>Of practices that see Medicaid patients, 46% have had to limit the number of Medicaid patients they see due to the practice's current financial statement. Furthermore, several respondents who haven't had to limit the number of Medicaid patients note it is a possibility in the future.</p> <ul> <li><em>We will have to limit should funding continue not to match inflationary increases.</em></li> <li><em>Not yet, but soon going that route.</em></li> <li><em>That could happen. That's what other practices are doing.</em></li> <li><em>We had a much larger number of Medicaid patients, but due to very poor financial return, we had to stop taking any new Medicaid patients, as well as turning away others that once were patients, but we hadn't seen within a year. We were going broke and didn't want to close our clinic.</em></li> <li><em>We have always had open access to all children, but for the first time in our 42-year history we are not taking new patients. We are unable to attract MDs to fill vacancies because we cannot compete with larger institutions that either do not take Medicaid or cap the number of Medicaid patients at a low rate.</em></li> <li><em>We had to discontinue providing eyewear to our Medicaid patients through the state plan. The payment of $20 per pair of eyewear was resulting in a substantial net loss.</em></li> <li><em>This remains the toughest population for us to see, primarily because the reimbursement is so low.</em></li> </ul> <h3>Without support patient access will suffer over the next year</h3> <p>Medical practices were asked if they will be able to provide the same level of patient access a year from now if staffing and financial trends continue. Just over 50% said they are not confident.</p> <h3>Medicaid rate increase a commonly cited solution</h3> <p>When asked if raising Medicaid rates to Medicare levels would be sufficient to maintain current Medicaid patent caseload, 63% said that would be sufficient; 37% said they would be able to increase their Medicaid caseloads.</p> <ul> <li><em>If (Medicare and Medicaid) rates were the same, we would consider increasing our caseload.</em></li> <li><em>Medicaid reimbursement has not increased in 20 yrs. Wages have changed dramatically.</em></li> <li><em>Variance in reimbursement (between Medicaid and other payers) is no longer sustainable.</em></li> <li><em>Increase in reimbursement for patient care would be helpful to keep on track with the other costs due to inflation.</em></li> </ul> <h3>Prior authorization an enormous burden for medical practices</h3> <p>Without prompting by the survey, several respondents noted the toll administrative burden and prior authorization requirements contribute to economic and staffing challenges:</p> <ul> <li><em>Work to increase reimbursement and cut red tape. Prior authorizations are a killer for staff.</em></li> <li><em>Help to improve prior authorization used as tactic to delay and deny care. Payer abuse in paying for approved services. Improve Medicaid rates to Medicare rates.</em></li> <li><em>Decrease administrative burdens and barriers which add to cost of overhead and do not add value to practice, i.e., prior authorization, poor EHR interoperability, regular insurance audits, increasing reimbursement for primary care, reimbursement for nutritional counseling, improving access to MHP.</em></li> <li><em>Commercial payers need to jump in and help by ending the onerous prior authorization processes. This alone would free up hours of precious staff time.</em></li> </ul> </div>12/19/2022 12:00:00 AM1/1/0001 12:00:00 AM
weekly-rounds-december-16-2022-all-hands-on-deck-on-physician-paymentWeekly Rounds: December 16, 2022 - All Hands on Deck on Physician PaymentLatest_NewsShared_Content/News/Weekly_Rounds/2022/weekly-rounds-december-16-2022-all-hands-on-deck-on-physician-payment<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Weekly%20Rounds/Weekly-Rounds-Article-Graphic-2022-645x425px.png" class="pull-right" alt="Weekly Rounds logo" /></div> <h5>December 16, 2022</h5> <h2>All Hands on Deck on Physician Payment</h2> <p>Jennifer Hanscom, CEO</p> <p> The annual ritual of stopping Medicare cuts is once again upon us. </p> <p> It's frustrating that we find ourselves in that position once again, yet the good news is there appears to be energy at the federal level to reform the program in the coming year. In the meantime, however, it is extremely important that you take time out of your day and urge your local congressional representative to stop the year-end cuts from going into effect. If Congress fails to act, physician Medicare payments are scheduled to be cut by 4.5% on Jan. 1. Cuts of this magnitude would severely impede patient access to care by forcing many physician practices to close and thereby putting further strain on those that remained open during the pandemic. </p> <p> <a href="https://physiciansgrassrootsnetwork.org/be-heard?vvsrc=/campaigns/96014/respond" class="TextButton">Send your message today</a> </p> <p> The WSMA is also urging all of medicine here in Washington to join us in advocating for the state to increase Medicaid payments for all physicians. </p> <p> What that means is that in addition to you <a href="[@]wsma/advocacy/physician_advocacy/scheduling-a-meeting.aspx?WebsiteKey=c182ff6d-1438-4899-abc5-614681b54927&_zs=B3aFd1&_zl=UV3k8">reaching out to your local legislators</a> to urge their support, we also need specialty societies, county medical societies, and medical groups to join the effort as well. </p> <p> Our ask is for the final 2023-2025 biennium budget to include $134 million of state general fund dollars to increase Medicaid rates for all specialties to approximate the rates paid by Medicare, adjusting to inflation moving forward. This investment will leverage a more than 2:1 federal match equating to an overall investment of $423 million for physician services. </p> <p> What many legislators may not know is that through the course of the pandemic, Medicaid enrollment has increased by around 400,000, bringing total state enrollment to over 2.2 million. This means that almost 30% of our state's residents are now enrolled in Medicaid. </p> <p> At the same time Washington is among the states with the lowest Medicaid rates, particularly for specialty health care services where we rank <a href="https://www.kff.org/medicaid/state-indicator/medicaid-to-medicare-fee-index/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Other%20Services%22,%22sort%22:%22desc%22%7D">near the bottom</a> (47th), and is in the <a href="https://www.kff.org/medicaid/state-indicator/federal-matching-rate-and-multiplier/?currentTimeframe=0&sortModel=%7B%22colId%22:%22FMAP%20Percentage%22,%22sort%22:%22desc%22%7D">bottom quartile of states</a> in federal allocation for Medicaid funding. Physicians treating Medicaid patients do so at a financial loss-reimbursement rates for most specialty Medicaid services, for example, are 43% lower than Medicare rates, which are intended to cover the cost of providing care. </p> <p> <a href="https://www.healthaffairs.org/do/10.1377/forefront.20190401.678690/full/">Studies show</a> that raising Medicaid reimbursement rates is the most effective method of increasing physician participation in Medicaid networks. Prioritizing a broad-based Medicaid reimbursement rate increase will improve access to care for Washingtonians by expanding physician participation in Medicaid networks at a time when it is desperately needed and long overdue. </p> <p> This effort will require all hands on deck. As the WSMA <a href="[@]Shared_Content/News/Membership_Memo/2022/november-23/in-new-survey-practices-continue-to-grapple-with-economic-hardship?_zs=B3aFd1&_zl=dV3k8">recently reported</a>, physician practices across the state are grappling with the economic hardship caused by workforce shortages and inflation. Your participation to help head off Medicare reimbursement cuts and increase Medicaid rates is critical to our success in ensuring access to care for our state's patients. <a href="[@]wsma/advocacy/take_action/wsma/advocacy/take_action/take_action.aspx?hkey=3598752c-64f4-4866-a95a-7610f4e1dd25&_zs=B3aFd1&_zl=fV3k8">The WSMA has resources available for you to use as you reach out to your local legislators in advance of the 2023 session</a>. </p> </div>12/16/2022 12:00:00 AM1/1/0001 12:00:00 AM
access-to-care-will-continue-to-diminish-in-washington-without-intervention-new-survey-revealsAccess to Care Will Continue to Diminish In Washington Without Intervention, New Survey RevealsLatest_NewsShared_Content/News/Press_Release/2022/access-to-care-will-continue-to-diminish-in-washington-without-intervention-new-survey-reveals<div class="col-md-12"> <div class="col-sm-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div> <h5>December 14, 2022</h5> <h2>Access to Care Will Continue to Diminish In Washington Without Intervention, New Survey Reveals</h2> <p> SEATTLE, WA - Results from a <a href="[@]Shared_Content/News/Latest_News/2022/wsma-economic-impact-survey-of-physician-practices.aspx">new survey</a> indicate inflation and staffing shortages continue to severely strain Washington's medical practice community and hinder patients' ability to access care during a crucial period of recovery our state. If actions are not taken to shore up the outpatient practice community, access to care in our state will continue to diminish over the next year, creating even more pressure on our already overwhelmed hospitals. </p> <p> The survey* focused on practices that are not affiliated with a hospital system and are often the only care provided in some communities, including underserved and rural areas. Eighty-two physician practices responded, representing more than a thousand physicians and health care professionals that provide care to millions of Washingtonians. </p> <p> Survey toplines: </p> <ul> <li>Nearly 50% of respondents noted their practice has had to reduce patient access, including reducing office hours, services, and treatments, in response to staffing shortages.</li> <li>More than 30% have had to reduce patient access, including reducing office hours, services, and treatments, in response to inflation.</li> <li>Nearly 50% have had to limit the number of Medicaid patients they see due to the practice's current financial statement.</li> <li>Fewer than 10% have the minimum available cash required for operating expenses ("days cash on hand," defined as 18 weeks' worth), with nearly half of practices having less than four weeks' worth of available cash.</li> <li>Just over 50% expect further reductions in patient access a year from now if staffing and financial trends continue</li> <li>Increasing Medicaid reimbursements and reducing staffing strain from prior authorization requirements were the most commonly cited solutions to easing the pressures experienced by practices.</li> </ul> <p> Survey respondent TRA Medical Imaging, which provides imaging services for over a million South Puget Sound patients in multiple outpatient clinic locations, has been forced reduce office hours as well as access to treatments, and is experiencing severe patient backlogs. TRA President and practicing radiologist Douglas Seiler, MD, said, "This is a very difficult time for our clinics. The last thing we ever want to do is reduce the care we provide to our patients, but in this economy, stagnant reimbursements and insurer requirements that add significantly to our practice and staffing costs leave us little choice." </p> <p> "The WSMA is concerned that there may be patients facing problems accessing basic care in their communities, and if we don't prioritize our community practices and clinics now, the problem will only get worse" said Jennifer Hanscom, chief executive officer of the WSMA, representing nearly 12,500 physicians and physician assistants statewide. "These community practices are critically needed to prevent increasing volume and strain on our already stressed hospital emergency departments, and in the long-term, to support the ability of patients to access care in their communities." </p> <p> The WSMA is urging Washington lawmakers and patients to support two initiatives in the upcoming state legislative session that could help keep practices open and patient care widely available: </p> <ul> <li>The WSMA is asking the Legislature to raise Medicaid rates for all physician specialties to adequately cover expenses, as physician groups overwhelmingly report that doing so will help stabilize finances and maintain access for current Medicaid patients or help increase their Medicaid caseloads. Today, Medicaid covers 30% of the state's patient population, and while businesses in other industries may increase prices to address inflation, medical practices seeing Medicaid patients are constrained from doing so as the state legislature sets Medicaid rates.</li> <li>The WSMA will support legislation that would reduce administrative burden by reining in insurance carrier prior authorization practices, which limit access to care for patients and would also relieve staffing challenges currently felt by most of the physician community.</li> </ul> <p> "Physician practices and ambulatory surgery centers are the first line of defense for patient health, and it's essential that they are supported to ensure patients can get basic care and have their health needs managed and addressed at the right time and at the right place," Hanscom said. "Raising Medicaid rates and reducing staffing pressures from burdensome prior authorization insurer requirements would be a shot in the arm for our practices-and for some, a lifeline-by helping to keep doors open and care available to all Washingtonians when and where they need it." </p> <p> Interview opportunities with some physicians who participated in this survey are available. </p> <p> *The survey was shared in October and November with 5,000 physicians working in independent (non-networked) physician clinics. 26% of survey respondents were solo practitioners. 44% were in practices of 2-10 physicians and 7% were in practices of 11-20 physicians. 12% of respondents represented practices of 21-50 physicians, and 11% represented practices with over 51 physicians. </p> <p><strong> For more information, contact:</strong> </p> <p> Cindy Sharpe<br /> Communications, Washington State Medical Association<br /> <a href="mailto:cindy@wsma.org">cindy@wsma.org</a> / 813.244.2883 </p> <p> <strong>About the Washington State Medical Association</strong><br /> The WSMA represents nearly 12,500 physicians, physician assistants, resident physicians, and medical students across all specialties and practice types in Washington state. The WSMA has advocated on behalf of the house of medicine for more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care. </p> </div>12/14/2022 12:00:00 AM1/1/0001 12:00:00 AM
action-alert-how-you-can-help-cancel-medicare-payment-cutsAction Alert! How You Can Help Cancel Medicare Payment CutsLatest_NewsShared_Content/News/Membership_Memo/2022/december-9/action-alert-how-you-can-help-cancel-medicare-payment-cuts<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/december/medicare-cta-1-645x425px.png" class="pull-right" alt="Protect patient access to care illustrated graphic" /></div> <h5>December 9, 2022</h5> <h2>Action Alert! How You Can Help Cancel Medicare Payment Cuts </h2> <p>If Congress fails to act soon, physician Medicare payments will be cut by 4.5% on Jan. 1, 2023, due to regulatory changes enacted by the Centers for Medicare and Medicaid Services. Cuts of this magnitude would severely impede patient access to care and place further strain on an already stressed practice community. When adjusted for inflation, Medicare physician payments have dropped by 22% from 2001 to 2021. Physicians simply cannot afford to operate under the current payment system.</p> <p>We have been raising the red flag over these cuts for months-and lawmakers are beginning to listen. But we need to keep the pressure on. The "lame duck" session of Congress is always a chaotic time with numerous priorities and interests vying to be included in the final must-pass package. It's urgent that the physician community push back on these cuts and ensure that physicians and patients don't get lost in the end-of-year shuffle.</p> <p><strong>What can you do to help cancel the cuts:</strong></p> <ol> <li>Contact your lawmakers through this link and share it with your colleagues: <a href="http://www.bit.ly/PhysicianMedicare">www.bit.ly/PhysicianMedicare</a></li> <li>Share this link with your patients: <a href="http://www.bit.ly/PatientMedicare">www.bit.ly/PatientMedicare</a></li> <li>Reach out to your member of Congress to schedule a meeting/phone call. <ul> <li>Download the AMA'sCancel the Cuts Action Kit: <a href="http://www.bit.ly/MedicareActionKit">bit.ly/MedicareActionKit</a></li> <li>Contact <a href="mailto:PoliticalAffairs@ama-assn.org">PoliticalAffairs@ama-assn.org</a> if you need help connecting with your member of Congress or need tips on how to effectively communicate your message and prepare for your meeting.</li> </ul> </li> </ol> <p>Time is running out. <a href="https://physiciansgrassrootsnetwork.org/be-heard?vvsrc=/campaigns/96014/respond">Contact Congress now</a> and demand that they protect patients and practices by canceling these devastating Medicare cuts in their entirety before the clock strikes zero.</p> </div>12/9/2022 12:00:00 AM1/1/0001 12:00:00 AM
local-health-officers-and-health-care-leaders-recommend-wearing-masks-indoorsLocal Health Officers and Health Care Leaders Recommend Wearing Masks IndoorsLatest_NewsShared_Content/News/Press_Release/2022/local-health-officers-and-health-care-leaders-recommend-wearing-masks-indoors<div class="col-md-12"> <div class="col-sm-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div> <h5>Dec. 9, 2022</h5> <h2>Local Health Officers and Health Care Leaders Recommend Wearing Masks Indoors</h2> <p> Communities across our state and around the U.S. are experiencing an unprecedented surge in viral respiratory illnesses, including respiratory syncytial virus (RSV), influenza, and COVID-19. As health officers and health care leaders working to improve the health of Washington residents, we recommend that everyone wear a high-quality, well-fitting mask when around others in indoor spaces to protect against both acquiring and spreading these infections to others. </p> <p> We also urge everyone who is eligible to stay up to date on your vaccinations. Vaccinations are the most important way to protect against severe influenza and COVID-19 infections, including hospitalization and death. Everyone 6 months and older should be vaccinated against these diseases and those who are eligible for an updated COVID-19 booster should get it now. </p> <p> Other necessary strategies include: </p> <ul> <li>Staying home from work and school and testing for COVID-19 if you develop symptoms.</li> <li>Having a plan for rapid treatment for COVID-19 and influenza for people who are at increased risk for severe infections.</li> <li>Improving indoor air quality through ventilation, filtration, and UV technology where appropriate.</li> </ul> <p> We expect the flu to circulate for months, so now is the time to get your flu shot! </p> <p> The flu is most dangerous for: </p> <ul> <li>Children under 5 years (especially under 2).</li> <li>Adults 65 years or older.</li> <li>Those who are pregnant.</li> <li>Anyone living with a health condition like asthma, diabetes, or heart disease.</li> </ul> <p> Consult with your physician or health care provider about the need for testing or treatment if you are at increased risk for severe influenza or are unsure. </p> <p> In addition to RSV and influenza, new COVID-19 variants are taking hold and immunity from past vaccination is waning for many people who have not yet received an updated booster shot. The surge in these viruses is resulting in many illnesses, contributing to rising absenteeism in schools this fall. This impact extends to businesses, workers, and families. </p> <p> For people who develop symptoms, and for parents of young children, it’s important to <a href="https://www.marybridge.org/for-patients-families/where-to-seek-care/">know when to contact your physician or health care provider for advice or an evaluation</a>. </p> <p> Working together and using multiple, layered strategies to limit the spread and impact of these viruses will provide benefits to all of us during this fall and winter respiratory virus season and help relieve serious stress on our health care system. </p> <p> Thank you to everyone for doing what you can to help. </p> <h3>Local health officers</h3> <p> Dimyana Abdelmalek, MD, MPH, Health Officer, Thurston County Public Health<br /> Allison Berry, MD, MPH, Health Officer, Clallam and Jefferson Counties<br /> Anthony L-T Chen, MD, MPH, Director of Health, Tacoma-Pierce County Health Department<br /> Jeff Duchin, MD, Health Officer, Public Health - Seattle and King County<br /> Amy Harley, MD, MPH, Co-Health Officer, Whatcom County Health Department<br /> Frank James, MD, Health Officer, San Juan County Health & Community Services<br /> Steven Krager, MD, MPH, Deputy Health Officer, Clark, Pacific and Skamania Counties<br /> Mark Larson, MD, Health Officer, Kittitas County Public Health Department<br /> James Lewis, MD, MPH, Health Officer, Snohomish Health District<br /> Alan Melnick, MD, MPH, Health Officer, Clark, Pacific and Skamania Counties<br /> Gib Morrow, MD, MPH, Health Officer, Kitsap Public Health District<br /> Greg Thompson, MD, MPH, Co-Health Officer, Whatcom County Health Department</p> <h3>Health care leaders</h3> <p> June M. Altaras, MN, NEA-BC, Executive Vice President, Chief Quality, Safety and Nursing Officer, MultiCare Health System<br /> Michael H. Anderson, MD, Chief Medical Officer, Virginia Mason Franciscan Health<br /> Mike Barsotti, MD, FAAP, President, Washington Chapter of the American Academy of Pediatrics <br /> Tori Bernier, Chief Nursing Officer, Summit Pacific Medical Center<br /> Timothy Dellit, MD, interim Chief Executive Officer, UW Medicine, interim Executive Vice President for Medical Affairs and interim Dean of the UW School of Medicine<br /> Mike Glenn, MHA, Chief Executive Officer, Jefferson Healthcare<br /> Jennifer A. Graves, RN, MS, Vice President, Quality and Safety, Kaiser Permanente Northwest and Kaiser Permanente Washington, Regional Chief Nursing Executive, Kaiser Permanente Washington<br /> Sean Gregory, Chief Executive, PeaceHealth Southwest Medical Center<br /> Carlton Heine, MD, PhD, FACEP, FAWM, Chapter President, Washington American College of Emergency Physicians<br /> Mark Johnson, MD, President, Washington Academy of Family Physicians<br /> Scott Kennedy, MD, Chief Medical Officer, Olympic Medical Center<br /> Robb Kimmes, Chief Executive Officer, Skyline Health<br /> David Knoepfler, MD, MBA, Chief Medical Officer, FACP, FHM, Overlake Medical Center<br /> Onora Lien, Executive Director, Northwest Healthcare Response Network<br /> Carma Matti-Jackson, President & Chief Executive Officer, Washington Health Care Association<br /> Ruth McDonald, MD, Chief Medical Officer, Seattle Children’s<br /> Deb Murphy, MPA, J.D., President & Chief Executive Officer, LeadingAge Washington<br /> Ettore Palazzo, MD, FACP, Chief Medical & Quality Officer, EvergreenHealth<br /> Charles Prosper, Chief Executive Officer, PeaceHealth St Joseph Medical Center<br /> Katina Rue, DO, President, Washington State Medical Association<br /> Cassie Sauer, President & Chief Executive Officer, Washington State Hospital Association<br /> Arooj Simmonds, MD, Regional Chief Medical Officer, Puget Sound Region, Providence Swedish<br /> Dori Unterseher MN, RN, Chief Nursing Officer, Harbor Regional Health<br /> Lynnette Vehrs, RN, MN, President, Washington State Nurses Association<br /> Darryl Wolfe, Chief Executive Officer, Olympic Medical Center</p> <p> For more information, contact: </p> <p> Graham Short<br /> WSMA Director of Communications<br /> 206.329.6851 (cell/text)<br /> <a href="mailto:gfs@wsma.org">gfs@wsma.org</a> </p> <h3>About the WSMA</h3> <p> The Washington State Medical Association represents more than 12,000 physicians, physician assistants, resident physicians, and medical students in Washington state. The WSMA has advocated on behalf of the house of medicine more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care. </p> </div>12/9/2022 12:00:00 AM1/1/0001 12:00:00 AM
 
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